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Boys to Men Health Survey
This survey is designed to give us information about your health knowledge, attitudes, and behaviors.
Please answer all of the questions honestly.
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* Indicates required question
What is your name?
*
Your answer
How old are you?
*
Your answer
Are you a boy or girl?
*
Boy
Girl
Prefer not to say
Who do you live with most of the time?
*
Single Parent
Two Parents
Guardian
Other:
How do you describe yourself?
*
White
Black or African American
Hispanic or Latino
Asian or Pacific Islander
American Indian or Alaskan Native
Other:
What grade are you in?
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Other:
What grades do you usually get in school?
*
A
B
C
D
F
How many days were you absent from school last year?
*
None
1-2
3-6
7-15
16 or more
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